Antenatal corticosteroids: are incomplete courses beneficial?

Elimian, Andrew; Figueroa, Reinaldo; Spitzer, Alan R.; Ogburn, Paul L.; Wiencek, Vandy; Quirk, J. Gerald

doi:10.1016/s0029-7844(03)00485-x

Cited by 63 publications

(47 citation statements)

References 9 publications

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“…These findings underscore the need to compare inflammatory cells/patterns in preterm placentas with those in term placentas to arrive at meaningful relations between HCA and preterm delivery. Previous studies have often focused solely on HCA in preterm placentas (21,26,33,45,52), and many studies have used a low polymorphonuclear leukocytes/high-powered field threshold to define HCA (24,38,47), which would have an attenuating effect on the HCA-preterm delivery association. The high prevalence of low intensity HCA in term placentas may mark the beginning of a maternal response to microbial ascent during labor.…”

Section: Discussionmentioning

confidence: 99%

“…Most studies can be grouped into one of two categories: those that have used inflammatory cell thresholds (i.e., polymorphonuclear leukocytes/high-powered field) (24,38,(43)(44)(45)(46)(47)(48) and those that have incorporated a complex HCA grading and/or staging approach (49)(50)(51). Within the first category, HCA criteria have varied with respect to 1) the tissue components included, for example, placental disc, extraplacental membranes, and cord (33,42,47,52), disc only (24,25,38,40,53), or extraplacental membranes only (41,43,44,48); 2) threshold, for example, ''any inflammation'' (25,33,34,42,52,53), greater than five polymorphonuclear leukocytes/ high-powered field (24,38,47), and greater than 10 polymorphonuclear leukocytes/high-powered field (43,45,46,48); and 3) number of high-powered fields that must exceed the threshold (43,46,48). In the second category, the detailed systems of staging/grading have also varied.…”

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confidence: 99%

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Histologic Chorioamnionitis and Preterm Delivery

Holzman

Lin

Senagore

et al. 2007

American Journal of Epidemiology

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Inconsistent findings linking placental histologic chorioamnionitis (HCA) and preterm delivery may result from variations in HCA definition, population studied, and exclusion criteria. This analysis from the 1998-2004 Pregnancy Outcomes and Community Health Study (five Michigan communities) includes the first 1,053 subcohort women (239 preterm, 814 term) with completed placental assessments. Multiple HCA definitions were constructed by 1) varying polymorphonuclear leukocytes/high-powered field thresholds and placenta components included and 2) using polymorphonuclear leukocyte characteristics to assign low/high maternal, fetal inflammation stage and grade. In African Americans, HCA was associated with preterm delivery before 35 weeks. The effect size was modest for polymorphonuclear leukocytes/high-powered field thresholds of greater than 10 and greater than 30 (odds ratios (ORs) ¼ 0.8 and 2.0); larger for greater than 100 (OR ¼ 3.2, 95% confidence interval (CI): 1.4, 7.1); strengthened after excluding medically indicated preterm deliveries (OR ¼ 4.9, 95% CI: 2.0, 11.8); and strongest for high maternal/high fetal HCA (OR ¼ 5.6, 95% CI: 1.4, 22.1). These latter HCA criteria also produced the largest effect size in Whites/others (OR ¼ 2.7, 95% CI: 0.3, 26.9). Among preterm deliveries before 35 weeks excluding those medically indicated, 12% of Whites/others and 55% of African Americans had high maternal HCA. The authors conclude that HCA definition, exclusion criteria, and race/ethnicity influence the HCA-preterm delivery association and that HCA contributes to preterm delivery-related ethnic disparity.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Histologic Chorioamnionitis and Preterm Delivery

Holzman

Lin

Senagore

et al. 2007

American Journal of Epidemiology

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“…Mean blood pressure is higher in preterm infants whose mothers received antenatal steroids [12,13,14,15]. Moise et al [12] found that extremely preterm infants whose mothers received antenatal steroids required less blood pressure support.…”

Section: Has the Problem Gone Away?mentioning

confidence: 99%

“…Demarini et al [13] also identified that mean blood pressures during the first 24 h after birth were increased in very low birth weight infants whose mothers received antenatal steroids. Another study found that even one dose of betamethasone compared to none was associated with a significant reduction in the need for vasopressors (OR 0.35, 95% CI 0.14-0.85, p < 0.02) [14]. Placental transfusion is associated with higher blood pressures [16] but effects on blood flow are not as clearly evident and it is not certain if milking the umbilical cord is better than delayed cord clamping.…”

Section: Has the Problem Gone Away?mentioning

confidence: 99%

What Should We Do about Low Blood Pressure in Preterm Infants

Dempsey¹

2017

Neonatology

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The management of preterm infants with low blood pressure soon after birth remains unresolved. The definition of what constitutes low blood pressure is uncertain. At birth, mean blood pressure appears to be gestation specific and increases in the first few days of life. Antenatal steroids, delayed cord clamping, and the avoidance of mechanical ventilation are all associated with higher mean blood pressure and less hypotension after birth. Rates of hypotension of 15-50% have been reported in various studies of extremely preterm infants. However, only about 10% of all extremely preterm infants receive inotropes, suggesting that clinicians take into account other factors such as clinical, biochemical, and echocardiographic findings before deciding to intervene. The exact role of functional echocardiography in assessing the need for treatment of low blood pressure in extremely preterm infants remains to be determined. Near- infrared spectroscopy to assess cerebral perfusion may also have a role to play. Volume expansion (usually 10 mL/kg of saline) remains the most commonly used intervention for low blood pressure but evidence of benefit is lacking and there may be safety concerns. Whilst dopamine is the most commonly used inotropic drug, dobutamine, epinephrine, corticosteroids, milrinone, and vasopressin have also been utilised in preterm infants with low blood pressure. Clinical trials with long-term outcomes are needed to determine the most suitable inotrope and when to use it. Early hypotension differs from late hypotension with regard to cause, treatment, and outcome. A number of recent studies aimed at improving the evidence base for the treatment of early hypotension in extremely preterm infants have been terminated early because of poor recruitment. Currently, the answer to the question of what to do about low blood pressure in preterm infants remains unclear.

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“…The effect of antenatal steroid use on PDA has also been controversial (decreased risk [18,25], no effect [26], increased risk [27]). However, there is no convincing explanation for the increased risk for sPDA seen in this study.…”

Section: Discussionmentioning

confidence: 99%

Very Low Birth Weight Monochorionic Diamniotic Twins as a Risk Factor for Symptomatic Patent Ductus Arteriosus

Yamaguchi

Wada²,

Nagasawa³

et al. 2016

Neonatology

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Background: Some prior studies have shown that symptomatic patent ductus arteriosus (sPDA) is highly familial. Although it is estimated that both genetic and environmental factors may contribute to sPDA, evidence is still lacking. Objective: The aim of this study was to determine the risk factors for sPDA, focusing on the genetic and in utero environment by analyzing very low birth weight (VLBW) singletons and twins. Methods: This retrospective case-control study reviewed the medical records of 445 VLBW infants (25 weeks ≤ gestational age <32 weeks, 600 g ≤ birth weight <1,500 g) and compared the incidence of sPDA among monochorionic diamniotic (MD) twins (n = 65), dichorionic diamniotic (DD) twins (n = 66), and singletons (n = 314). Results: Stepwise multiple regression analysis showed that twin siblings (p = 0.001), gestational week (p < 0.001), antenatal steroid use (p = 0.021), and premature rupture of membranes (p = 0.002) were independent predictors of sPDA. Incidence of sPDA in MD twin siblings was significantly higher than that in singletons (p < 0.01), whereas no significant difference was found between singletons and DD twins or between MD and DD twins. Conclusions: The current results show that being a VLBW MD twin is an independent risk factor for sPDA, and that both genetic and in utero environmental factors may contribute to its development.

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Antenatal corticosteroids: are incomplete courses beneficial?

Abstract: An incomplete course of antenatal corticosteroids is associated with reduction in the need for vasopressors, the rate of intraventricular hemorrhage, and neonatal death in preterm neonates.

Cited by 63 publications

References 9 publications

Histologic Chorioamnionitis and Preterm Delivery

Histologic Chorioamnionitis and Preterm Delivery

What Should We Do about Low Blood Pressure in Preterm Infants

Very Low Birth Weight Monochorionic Diamniotic Twins as a Risk Factor for Symptomatic Patent Ductus Arteriosus

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